Monday, February 18, 2019

The same Italian
government dreamers who brought us the Great Leap Forward in medical education I
talked about in my last post – the ones who suggested that the doors of medical
school be opened to all comers and that postgraduate education become optional –
are running a new idea up the flagpole, this time for teachers. Five Star policy
wonks have come up with the idea of offering them Continuing Education classes
in a new field: exorcism. Yes, the Five-Star Movement’s
Minister of Education is allowing educators to earn points valid for higher pay
and promotions by taking 40-hour courses, taught by priest expert in the
casting out of demons. Any teacher willing to shell out €400 ($452) can now
learn both the theory and the “correct
practice” of prayers that might be useful at least, one hopes, to keep a
few little devils in their seats.

But why
stop at teachers? Doctors would surely be even better students of the White Arts.
There’s always been a subset of Italian psychiatrists who boast of being able
to tell which patients’ bizarre behavior is from mental illness and which is
the handiwork of Satan. Until now they’ve had to hand over the possessed variety
to priests for the performance of demon amputation. Perhaps in the future my
colleagues and I will be able to graduate from mere diagnosis to treatment while
fulfilling our Continuing Medical Education requirements, by learning to chant
for ourselves the proper invocations against
the cursed dragon and his diabolical legions.

You can
already earn Continuing Medical Education credits in Italy by studying contract
bridge. A practical class in the treatment of demonic possession wouldn’t
be much of a stretch.

By the
way, this mishegoss is not special to Italy. According to an in-depth Atlantic
article just two months ago, half of Americans believe in demonic
possession, and the exorcism business is booming.

Thursday, February 14, 2019

When I first moved to Italy, any high school graduate who thought
they might like to be a doctor had the right to give medical school a whirl.
Because of this open admissions policy, ten times more physicians were churned
out each year than the country needed. And because there was no way those
hordes of students could get individual attention from their teachers, and far
too few bodies for them to learn on, you could graduate from med school without
having ever touched a patient. Literally. Italian medical training was so
notorious that when the European Union started recognizing degrees and
specializations across borders, Italy risked being the only country excluded.

The threat of that humiliation goaded Italy to begin a minor
revolution. By the turn of the century a system of selection for medical school
had been introduced (based on a multiple-choice test), freshman classes had
been slashed by 90%, and students were starting to be taught at patient bedsides
instead of only from books. Italian medical training was making giant strides
toward joining the rest of Europe.

Now, twenty years after Italian doctors began their Long March from
laughingstocks to world-class clinicians, the Italian Health Minister, Giulia
Grillo—a physician previously known mainly for waffling on the need for
vaccination—has been crusading to turn back the clock by bringing
back open admissions for medical school.
No more tests. No more selection process. Anybody who made it through high
school would again be welcome. Come one, come all!

Dr. Grillo, from the Five-Star Movement, has even added a sour cherry on top: the downgrading
of postgraduate training. She points out, correctly, that due to sloppy
planning Italy has gone from too many prospective General Practitioners to too
few, and trains far too few specialists in emergency medicine to keep hospital
Emergency Rooms properly staffed. Her proposed solution? Stop requiring docs hired
for those jobs to have any residency training. Instead, she says, hospitals
should be able to employ anybody with experience, such as night coverage
(Guardia Medica) on the National Health Service, assuming they’ll have picked
up their trade by osmosis. Even worse, she’s suggested maybe those ER docs and
GPs could be hired fresh out of medical school. Anywhere in the world that
would be a mistake, given the complexity of modern medicine, but in Italy—where
medical school is still relatively weak on the practical—it would be madness.

Already many young Italian medical graduates flee the country, headed
for nations where they expect superior specialty training, higher stipends, and
eventually a better chance at real jobs. And already Italian specialty training
is uneven, turning out specialists whose levels of competence range from superb
to iffy. If even that spotty training is turned into an optional, with
self-taught doctors handling heart attacks and accident victims . . . poor
Italy!

Pardon my rant. I’ve never been good at buddhistic acceptance,
and the coronation of Donald Trump reset my indignation threshhold even lower.
By now even a considerably less dangerous Italian Minister of Health can
trigger it.

P. S. The picture of a medical school lecture hall at the top of
this post was from 2014, when the admission process was highly selective. Imagine
how packed those halls used to be when ten times as many students were
enrolled, and how they will be again if Dr. Grillo gets her way.

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.